[Practical refinaments in simplified laparoscopic pyeloplasty]. / Refinamientos prácticos en la pieloplastia laparoscópica simplificada.

OBJECTIVES: Laparoscopic pyeloplasty (LP) is the treatment of choice for ureteropelvic junction obstruction (UPJO). We present the 3-trocars LP technique with several considerations and practical advices. METHODS: Several maneuvers to optimize exposure and simplifying the implementation of the operation were showed. A total of thirteen patients with UPJO and criteria for surgical treatment were included, and were operated using the 3 trocars LP technique. Demographic data, perioperative and follow-up were collected retrospectively. RESULTS: Mean operative time was 132 minutes. No conversion to open surgery was registered and additional trocar insertion was not required. Neither perioperative complications nor postoperative complications were reported. Three patients needed ureteral stenting preoperatively for pain. Five patients required flexible nephroscopy with CO2 for extraction of calyceal stones. The pain was controlled in all cases. CONCLUSIONS: The LP is a feasible and safe technique for the surgical correction of UPJO, and maneuvers presented in this study simplify the procedure and may be applied in other laparoscopic procedures.

Refinamientos prácticos en la pieloplastia laparoscópica simplificada / Practical refinaments in simplified laparoscopic pyeloplasty

OBJETIVO: La Pieloplastia Laparoscópica (PL) es el tratamiento de elección de la Obstrucción de la Unión Pieloureteral (OUPU). Presentamos la técnica ilustrada de PL con tres trócares con refinamientos y consejos prácticos. MÉTODOS: Se describen varias maniobras paso a paso, para optimizar la exposición y simplificar la ejecución de la cirugía. Un total de trece pacientes con OUPU con criterios para tratamiento quirúrgico fueron incluidos. Todos ellos fueron operados de PL empleando 3 trócares. Los datos demográficos, perioperatorios y de seguimiento fueron recolectados de manera retrospectiva. RESULTADOS: El tiempo operatorio promedio fue de 132 minutos, no hubo conversión a cirugía abierta ni se requirió inserción de trocar adicional en ninguno de los casos. No se reportaron complicaciones perioperatorias ni post-operatorias. Tres casos requirieron inserción de catéter doble J previamente por dolor. Cinco pacientes requirieron nefroscopia flexible con CO2 para la extracción de litiasis caliciales. Todos los casos presentaron desaparición del dolor. Conlcuisones: La PL con tres trocares es una técnica factible y segura en la corrección quirúrgica de la OUPU, y las maniobras presentadas en este estudio simplifican el procedimiento y pueden tener aplicación en otras intervenciones laparoscópicas

OBJECTIVES: Laparoscopic pyeloplasty (LP) is the treatment of choice for ureteropelvic junction obstruction (UPJO). We present the 3-trocars LP technique with several considerations and practical advices. METHODS: Several maneuvers to optimize exposure and simplifying the implementation of the operation were showed. A total of thirteen patients with UPJO and criteria for surgical treatment were included, and were operated using the 3 trocars LP technique. Demographic data, perioperative and follow-up were collected retrospectively. RESULTS: Mean operative time was 132 minutes. No conversion to open surgery was registered and additional trocar insertion was not required. Neither perioperative complications nor postoperative complications were reported. Three patients needed ureteral stenting preoperatively for pain. Five patients required flexible nephroscopy with CO2 for extraction of calyceal stones. The pain was controlled in all cases. CONCLUSIONS: The LP is a feasible and safe technique for the surgical correction of UPJO, and maneuvers presented in this study simplify the procedure and may be applied in other laparoscopic procedures

Narrowing of the dorsal vein complex technique during laparoscopic radical prostatectomy: a simple trick to simplify the control of venous plexus.

PURPOSE: The control of the Dorsal Venous Complex (DVC) is crucial to the recovery of urinary continence during Laparoscopic Radical Prostatectomy (LRP). The size of DVC may affect the venous control. We developed a trick to simplify the suturing of the DVC. MATERIALS AND METHODS: Forty-seven patients with localized prostate cancer were divided in two groups: group 1 (n = 24) underwent LRP with a conventional ligature of DVC, and in group 2 (n = 23) the venous control was done with "Narrowing" of DVC technique (N-DVC). Our technique involves maintaining pressure on a metallic urethral sound inserted into the urethra, just at the time of ligature. The width of DVC in group 2 was measured before and after applying the technique. The numbers of attempts to place the stitch adequately were recorded and compared in both groups. The demographic dates, perioperative dates and results were compared retrospectively. RESULTS: Operative time, estimated blood loss, prostate weight, positive surgical margins rates and potency results showed no significant differences between the groups. The immediate 1-month, and 3-month continence rates were significantly greater in group 2 (30.4% vs. 12.5%, P = .048; 73.9% vs. 50%, P = .037, respectively). For all patients in group 2, width of DVC decreased and the ligation stitch was effective at the first attempt. In 37.5% of patients in group 1, the controlling of the DVC was obtained in more than one attempt. CONCLUSION: The N-DVC simplifies the control of DVC during LRP and may contribute to the early recovery of continence.